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An updated Cochrane Review published 9 February has identified effective and safe ways to reduce unnecessary use of antibiotics in hospitals. Guidelines and policies that promote better targeting of antibiotics in patients who need them have the greatest impact when they are supported by the most effective ways to change doctors’ behaviour.

Antibiotics are used to treat bacterial infections, such as pneumonia. Antibiotic resistance has become a major public health problem with some infections no longer treatable using currently available drugs. Infections caused by antibiotic-resistant bacteria lead to longer hospital stays and carry a higher risk of death. Inappropriate use of antibiotics is associated with increased resistance, and studies have shown that about half of the time physicians in hospital are not prescribing antibiotics appropriately.

A team of Cochrane researchers from the UK assessed the effectiveness and safety of interventions to improve how physicians prescribe antibiotics to hospital inpatients. They also wanted to know how much variation there was among the different types of interventions they studied.

The researchers found 221 studies from the US, Europe, Asia, South America, and Australia. The interventions were aimed at healthcare professionals who prescribe antibiotics to hospital in-patients receiving acute care, and those undergoing planned surgery. The interventions broadly fell into two categories. ‘Restrictive’ techniques applied rules to make physicians prescribe properly, whilst ‘enabling’ techniques provide advice or feedback to help physicians make more informed prescribing decisions. In both cases, the aim was to increase the number of appropriate prescribing decisions so that patients who were unlikely to benefit from antibiotics did not get them, whilst they were still used for patients who stood to benefit from them.

The researchers found high-quality evidence from 29 randomized studies in 23,394 inpatients that following either type of intervention 58% of hospital in-patients received treatment in line with prescribing guidelines, compared with 43% of the patients in the standard practice groups. The interventions shorten the duration of antibiotic use from 11 days to 9 per patient, and probably reduce hospital stay from an average of 13 days to 12 per patient. Data from 28 randomized studies of 15,827 patients showed that the risk of death was 11% in both treatment groups, suggesting that reducing antibiotic use did not lead to an increase in harm. Data from 26 non-randomized studies provide only limited evidence of an association between adopting the interventions and a reduction in hospital infections.

Interventions that included enabling or restrictive techniques were consistently more effective than interventions that relied on simple education alone (e.g. meetings or distribution of guidelines). Moreover, adding enabling techniques increased the effectiveness of restrictive techniques. However, only 10% of interventions used the most effective enabling techniques, (goal-setting, feedback, and action planning.)

Cochrane lead author Peter Davey, from the Population Health Sciences Division at the University of Dundee in Dundee, UK said, “This Cochrane Review shows that a wide variety of different interventions have been successful in safely reducing unnecessary antibiotic use in hospitals.”

He added, “We do not need more studies to answer the question of whether these interventions reduce unnecessary antibiotic use, but we do need more research to understand why the most effective behaviour change techniques are not more widely adopted within hospital settings. Future research should instead focus on targeting treatment and assessing other measures of patient safety, and different interventions that explore the barriers and facilitators to implementation. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. Successful adoption of the interventions we have studied could have considerable impact on health service, policy, and future decision-making for patients.”

About Cochrane Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.

Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.

Cochrane is a not-for-profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

Find out more at cochrane.org

Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

Keen to get experience with systematic reviews, but not sure where to start? Or perhaps you’re already experienced, and want to help out?

TaskExchange is an online platform that connects people needing help with their systematic review with people who have the time and skills to help. A variety of tasks are posted on the platform, from literature searching, article screening and translation and data extraction, to statistical analysis and consumer reviews. Whether you’re a complete beginner or very experienced, you’re bound to find a task that suits you!

Jan Witowski, fifth year medical student from Poland, was looking for more systematic review experience when he came across TaskExchange. He says,

“I had started to work on reviews, and I noticed TaskExchange on the Cochrane webpage. I saw an author team wanted help translating a Polish trial article, so I volunteered to do that, and was acknowledged in the publication which was a bonus for my CV. The authors have since offered me more translation work. TaskExchange has made it easy to get involved in systematic reviews and I’d recommend it to anyone wanting experience in evidence synthesis."

To get started with TaskExchange, sign up, browse the tasks, and respond to the tasks that catch your eye!

Cochrane has partnered with Wikipedia to improve the evidence base of Wikipedia health articles

Cochrane has a commitment to producing and sharing high-quality medical evidence to as broad an audience as possible. As a way of achieving this, Cochrane has been working in partnership with Wikipedia since 2014 to improve the evidence base of health articles in Wikipedia, using quality, reliable secondary sources such as recent Cochrane Reviews to help improve the reliability of freely available health information.

The Cochrane-Wikipedia initiative supports the inclusion of relevant evidence within all Wikipedia health articles, as well as processes to help ensure that health information included in Wikipedia is of the highest quality and as accurate as possible. Trusted, evidence-based information can help people to make informed decisions about their own health and health care.

We welcome all who want to help improve the evidence base of health articles in Wikipedia. Whether you are a new to Wikipedia and Cochrane, or you are a seasoned Wikipedian or Cochrane contributor, your contribution is welcome!

This is a challenging and interesting opportunity for a technical business analyst to contribute to a non-profit organisation with a social mission to improve health care for everyone.

Job description: You will be based in Cochrane’s Informatics and Knowledge Management Team, and you will have primary responsibility for specifying new features for Cochrane systematic review production software. You will translate user needs, business requirements, and gaps into actionable specifications for development and testing.

Requirements:The job requires the ability to analyse and investigate user needs and existing systems to define how new features should be implemented. You have working knowledge of data and process modelling, and can work with domain experts to understand their requirements. Over time you will gather a thorough understanding of the domain yourself. You understand the basics of user interface design, and can work in the context of an Agile development team.

About Cochrane:Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

Our work is recognised as the international gold standard for high quality, trusted information. We want to be the leading advocate for evidence-informed health care across the world.

Applying: If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Functional Analyst” in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities and skills which you feel are relevant to the post.

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.Our work is recognised as the international gold standard for high quality, trusted information. We want to be the leading advocate for evidence-informed health care across the world.

Job Description: This is exciting role for an individual passionate about HR and who would relish to provide HR support and advice to the Chief Executive Officer, Head of Finance and Core Services and other senior managers and Central Executive staff so that Cochrane policies are followed and good practice and legal obligations are met. This role will be 22.5 hours per week.

Requirements: The successful candidate will need to be extremely well organized to manage a high workload. We are looking for an experienced HR Manager with previous experience in this role with a proven collaborative approach to support and advise HR activity across Cochrane.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “HR Manager” in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities and skills which you feel are relevant to the post.

What were the most popular Cochrane Reviews of 2016? Find out in a Special Collection, now available on the Cochrane Library, which showcases some of the best work from Cochrane contributors worldwide. All of the included reviews are freely available via the Cochrane Library website.

South Asia is home for over 1.6 billion people, speaking hundreds of languages among them. At least 12 of these languages are each spoken by 30 million or more people. All the countries in this region are categorized as either low or lower-middle income economies. Though English remains the official medium of instruction and communication among healthcare professionals in this region, large proportions of the general population do not speak or read English. Impactful dissemination of health information among the people in a language they understand is therefore a huge challenge.

As part of an initiative to reach out to people speaking native languages, Cochrane South Asia has created webpages explaining the role of Cochrane in six major South Asian languages - Bengali, Hindi, Kannada, Malayalam, Tamil, and Telugu targeting a potential reader base of over 700 million people.

These webpages in vernacular languages have been drafted with the aim of helping South Asian people understand, in their own social and linguistic contexts, the work of Cochrane and systematic reviews in improving healthcare. User-testing of the content in each language was done to try and avoid redundant literal translations of technical terms, with the emphasis placed on readability as much as on conveying the right information.

“The impact of Cochrane in the countries in South Asia will be enhanced if more people who do not read English in the region understand the importance of the rigorous, and independent, approach used by Cochrane. This is likely to improve their trust in Cochrane evidence, “ says Dr Prathap Tharyan, Director of Cochrane South Asia.

In due course, Cochrane South Asia hopes to work with the Central Executive Team and other stakeholders to start translating Cochrane evidence in regional South Asian languages to benefit larger sections of the population.

Cochrane Switzerland, based at the Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, seeks immediately or by agreement aScientific Collaborator (0.6 FTE).

Cochrane (www.cochrane.org) is an international independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research accessible for those who need to make decisions about health. Cochrane is a not-for-profit organisation with contributors from over 120 countries working together to produce credible and accessible health information (in particular, systematic reviews) that is free from commercial sponsorship and other conflicts of interest. Cochrane Switzerland is an Associated Cochrane Centre and active in all three language regions (www.swiss.cochrane.org).

Roles: Contribute to the development of Cochrane Public Health Europe (i.e. the European satellite of the Cochrane Group for public health reviews, http://ph.cochrane.org) and Cochrane Switzerland in general. Contribute to dissemination and knowledge transfer projects, in particular in German language. Contribute to training and review projects as mandated by third parties.

Profile: Training in medicine or health sciences (Master degree or equivalent); training in public health desirable. Relevant working experience of 2 years or more. Knowledge of methods of epidemiology and concepts of evidence-based health care. Excellent proficiency and writing skills in German; at least intermediate proficiency in French and English. Fluent use of electronic communication tools. Team player but able to work with partners in an international network.

Please submit your application including a motivational letter and CV (with copies of diploma) between 1st and 22 January 2017 using the link that will be provided with the official job announcement at https://recrutement.chuv.ch.

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.Our work is recognised as the international gold standard for high quality, trusted information. We want to be the leading advocate for evidence-informed health care across the world.

Job Description: The successful candidate will join the existing Cochrane Information Specialist Support Team, which provides introductory and ongoing support and training related to Cochrane editorial processes, information technology, and study identification methods to the Cochrane Information Specialist (CIS) community. Support and training is guided by the needs of practicing CISs and current Cochrane policies and technology developments. The post is available for a fixed term of one year.

Requirements: The ideal candidate should have appropriate library or information science qualifications, current or recent experience of working as a CIS in a Cochrane Review Group, Field or Centre, an understanding of information, retrieval methodologies, particularly as they apply to the production of systematic reviews, experience in biomedical database searching, e.g., The Cochrane Library, MEDLINE, Embase, trial registries, etc.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with "CIS Support Team Member" in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities and skills which you feel are relevant to the post.

A new Cochrane Review, published in the Cochrane Library today, suggests that yoga may lead to a small reduction in pain in people with chronic non-specific lower back pain over the short term. However, researchers advise that more studies are needed to provide information on long-term effects.

Lower back pain is a common health problem, and is usually treated with self-care and over-the-counter medication. For some people it may last for three months or more, and at this point it is considered “chronic”. Back pain is sometimes associated with a disease or condition, but the vast majority of lower back pain cases have an unknown cause, and as a result are described as non-specific. Current guidelines state that exercise therapy may be beneficial, and in particular yoga is sometimes used as a treatment.

Yoga has gained global popularity as a form of mind-body exercise, with general lifestyle benefits, and recent studies have investigated the potential of yoga to relieve the symptoms of lower back related problems.

A new Cochrane Review summarizes the results of 12 randomized trials from 1,080 men and women with an average age between 34 and 48 years old. The trials were conducted in India, the UK, and the US. All participants had chronic non-specific lower back pain.

The Cochrane researchers compared practicing yoga in a class to not doing any back-focused exercise. Five studies compared yoga with back-focused exercise, or added yoga for a back-focused exercise programme. All yoga interventions used were specifically designed for treatment of lower back pain, and were provided by experienced and qualified teachers.

They found that compared to no exercise, practicing yoga might be able to improve back-related function and reduce symptoms of lower back pain by a small amount. However, larger and more robust studies are needed to draw any firm conclusions about the long-term health benefits of yoga.

The research team also found limited evidence that, compared with not doing any physical exercise, yoga can lead to some improvement in back function after six months and a small reduction in pain after three months. The longer term effects of yoga on lower back pain are less certain, because there were few studies that looked at follow-up after 12 months. However, yoga is associated with more side effects than not doing any exercise. About 5% more yoga participants experienced increased back pain, although this appears similar to the risk of having side effects from other back-focused exercise.

Lead Cochrane author Susan Wieland from Cochrane Complementary Medicine at the Center for Integrative Medicine, University of Maryland School of Medicine, Maryland, commented, “Our findings suggest that yoga exercise may lead to reducing the symptoms of lower back pain by a small amount, but the results have come from studies with a short follow-up. At the moment we only have very low-quality evidence for the effects of yoga before six months as a type of exercise for helping people with chronic lower back pain. The yoga exercises practised in the studies were developed for low back pain, but people should also remember that in each of the studies we reviewed, the yoga classes were led by experienced practitioners. The findings of this Cochrane Review will help people make more informed choices about their future treatment options.”

About CochraneCochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.

Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.

Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

Find out more at cochrane.org

Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

About WileyWiley, a global company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 200 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at www.wiley.com.

Voting is open for 2016/2017 election for four (4) internal members of the Cochrane Board. Voting will be done by the entire Cochrane membership - membership of Cochrane is defined as all contributors to a registered Cochrane Group with an Active role in Archie, excluding those whose only roles are Other, Mailing list, Possible Contributor, Super User, Web Contributor and Web Publisher. Eligible voters (see our Board Policy and Electoral Procedure) Eligible voters can now access the voting form. Voting closes on Wednesday, 25 January 2017.

To access the voting form, you will need to use your Cochrane (or Archie) login. If you are an eligible voter but do not have a Cochrane login, when asked to enter your details, click the link, and follow the instructions to create a new account. Use the name and email address usually used in your communications with Cochrane to ensure your access is granted. If you have any trouble logging in, please contact your Cochrane Group, or admin@cochrane.org.

Evidence reviews now incorporated into BMJ Best Practice to better inform decision making.

BMJ, one of the world’s leading medical knowledge providers, has teamed up with Cochrane Clinical Answers, a new resource from the Cochrane Library, to better deliver evidence and inform decision making at the point of care.

The collaboration means that Cochrane Clinical Answers are now incorporated into BMJ Best Practice topics to give health professionals instant access to the highest-quality evidence for use in their daily practice.

Cochrane Clinical Answers, an evidence tool produced and published by Wiley, are based on the results of Cochrane systematic reviews. They provide evidence-based answers to clinical questions to inform decision making at the point of care, focusing on outcomes that matter most to patients.

BMJ Best Practice gives doctors fast and easy access to the latest information when making diagnosis and treatment decisions. Updated daily, it draws on the latest evidence-based research, guidelines and expert opinion to offer step-by-step guidance on diagnosis, prognosis, treatment and prevention.

Systematic reviews are the cornerstones of evidence based medicine. They bring together evidence from existing research to help answer important clinical questions, identify harms, and inform clinical guidelines, practice and policies worldwide.

Without them, decision makers, students and researchers would be at the mercy of often conflicting studies or expert opinion.

BMJ Best Practice already has a strong evidence base, but by incorporating Cochrane Clinical Answers, it will give health professionals the confidence to make the best decisions in partnership with patients, even in areas of clinical uncertainty.

In fact, a recent independent review of clinical decision support tools published in the Journal of Medical Internet Research ranked BMJ Best Practice equal first for breadth of disease coverage, editorial quality, and evidence-based methodology.

Sharon Cooper, Chief Digital Officer, BMJ said: “Both BMJ and Cochrane have been at the forefront of the evidence based medicine movement since it began, and the goals of our two organisations are closely aligned. We look forward to working together to help busy health professionals make decisions that are linked as firmly as possible to the highest quality evidence available for the benefit of patients.”

Cochrane Editor in Chief, David Tovey said, “I am delighted Cochrane will be working together with BMJ and health professionals globally to make better, more informed health decisions. Cochrane Clinical Answers is an important evidence-based tool that provides decision-makers with the best available evidence so that they can make informed decisions at the point of care.”

About BMJBMJ is a healthcare knowledge provider that aims to advance healthcare worldwide by sharing knowledge and expertise to improve experiences, outcomes and value. For a full list of BMJ products and services, please visit bmj.com

About CochraneCochrane is a global independent network of researchers, professionals, patients, carers and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews. Cochrane is a not-for profit organisation with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognised as representing an international gold standard for high quality, trusted information. Find out more at cochrane.org Follow us on twitter @cochranecollab

About WileyWiley is a global provider of knowledge and knowledge-enabled services that improve outcomes in areas of research, professional practice, and education. Through the Research segment, the Company provides digital and print scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising. The Professional Development segment provides digital and print books, online assessment and training services, and test prep and certification. In Education, Wiley provides education solutions including online program management services for higher education institutions and course management tools for instructors and students, as well as print and digital content. The Company's website can be accessed at http://www.wiley.com.

Your chance to be part of the first ever Global Evidence Summit begins now…Call for abstracts opens on 5 January 2017

Opportunities to present special sessions, workshops, oral presentations, and poster abstracts open on 5 January 2017. This is your chance to be part of the Global Evidence Summit (GES) and we look forward to receiving abstracts around the theme: Using evidence, Improving lives.

This year, Cochrane, a global independent network of researchers, professionals, patients, carers, and people interested in health, is joining with four other leading organizations – the Guidelines International Network, The Campbell Collaboration, the International Society for Evidence-based Health Care, and the Joanna Briggs Institute - to hold the first ‘Global Evidence Summit’ (GES) in Cape Town, South Africa from 13-16 September 2017.

The theme of the GES, ‘Using Evidence. Improving Lives’, will highlight and promote evidence-informed approaches to health and social research, policy and development.

The summit will focus on the opportunities and challenges facing low- and middle-income countries - a key reason why the GES will be hosted in Cape Town, South Africa. The event is expected to attract up to 2000 delegates and will bring together many parts of the evidence community to promote evidence-informed decision-making worldwide.

We are very pleased to announce that Cochrane South Africa has appointed Charles Shey Wiysonge as its new Director, effective December 2016.

Originally trained as a physician, Professor Wiysonge has also completed extensive postgraduate training in epidemiology, evidence-based health care, and vaccinology. His previous roles have included serving as Senior Research Officer with the Joint United Nations Programme on HIV/AIDS in Geneva, Senior Scientist with the South African Medical Research Council, Senior Researcher and Programme Manager for the University of Cape Town’s Vaccines for Africa Initiative, and the Deputy Director of the Centre for Evidence-Based Health Care at Stellenbosch University. His association with Cochrane dates back to 2001, when he became the inaugural recipient of the Aubrey Sheiham Public Health and Primary Care Scholarship (from 2014 The Aubrey Sheiham Evidence-based Health Care in Africa Leadership Award). In addition to authoring multiple Cochrane Reviews, since 2014 Professor Wiysonge has been on the staff of Cochrane South Africa as Chief Specialist Scientist.

The Founding Director of Cochrane South Africa, Jimmy Volmink, will be stepping down from managing day-to-day operations at the Centre, but will continue to serve as Chair of the Global Organizing Committee for the 2017 Global Evidence Summit.

Cochrane CEO Mark Wilson said, ‘I congratulate and warmly welcome Professor Charles Wiysonge to his new role. This opens a new chapter for the South African Cochrane Centre following the outstanding leadership of Professor Jimmy Volmink over two decades; and I look forward immensely to working with Charles and the great team at Cochrane South Africa in the coming years as it leads efforts to build Cochrane’s impact on health and healthcare decision making across the whole continent.’

Professor Wiysonge, on taking over the Directorship, said, 'Jimmy has done an outstanding job, and filling his shoes is next to impossible. I am thus indebted to Cochrane South Africa for the trust bestowed on me to draft the next chapter in its history. At the same time, I am humbled by the task before us; the huge task of ensuring that healthcare decision making in Africa is informed by relevant, timely, and high-certainty synthesized research evidence. However, I have no doubt in my mind that with an engaged team at Cochrane South Africa, we shall deliver.'

Please join us in congratulating Professor Wiysonge and Cochrane South Africa as they begin this new era, and wishing them every success for the future.

Caregiver-mediated exercises may be a promising form of therapy to add to usual care.

Stroke is a major cause of acquired adult disability. Research has shown that more time spent on exercise therapy in the first weeks to months after stroke leads to better functioning and allowing early supported discharge. Due to lack of personnel and resources, in practice it is difficult to spend more time on exercise therapy in this period. One method to increase this exercise time is to involve caregivers in performing exercise training together with stroke patients. During this exercise training, a therapist coaches patient and caregiver and an evaluation is planned on a regular basis.

A team of Cochrane authors based in the Netherlands worked with Cochrane Stroke to determine if caregiver-mediated exercises improved ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. This meta-analysis included nine trials with a total of 333 patient-caregiver teams. The quality of included randomized controlled trials was low, resulting in low to moderate evidence.

The Cochrane Review found evidence that caregiver-mediated exercises could have a positive effect on patients' standing balance, quality of life directly after the intervention, and on basic activities of daily living. In the long term, they found evidence for a positive effect on walking distance. No significant side effects or beneficial effects on caregiver strain were identified.

“Having caregivers help stroke patients with exercising is a low-cost and simple intervention. Our Cochrane Review shows that caregiver-mediated exercises may be a promising form of therapy to add to the usual care,” said Judith DM Vloothuis from the Amsterdam Rehabilitation Research Centre, and lead author of the Cochrane Review. “Overall the quality of included trials was low to moderate, which requires replication. Our findings suggest that higher quality studies are needed, including analysis of the costs of this promising intervention. Currently, our research group is studying the cost-effectiveness of a caregiver-mediated exercises program combined with e-health facilities, initiated within the first weeks post stroke.”

Cochrane Connect brings you a monthly dose of news, events, and noteworthy Cochrane Reviews - right to your inbox.

Get the latest Cochrane news with our monthly newsletter, Cochrane Connect. It rounds up the month's most important Cochrane Reviews and biggest news stories, so you can stay up to date with the latest Cochrane information.

Each newsletter contains:

Feature stories from the Cochrane community

Cochrane Review news that includes links to free access collections, editorials, featured reviews, and press releases.

Organizational news which covers what Cochrane is up to and how you can get involved.

The review found significant evidence that routinely changing or replacing peripheral venous catheters is no better than replacing when clinically indicated. The Group has reported that this evidence has a potential cost saving to the NHS of £40 million over a five-year period.

Here’s its story from publication to informing policy.

How it beganMost hospital patients receive fluids or medications via an intravenous catheter at some time during their hospital stay. An intravenous catheter (also called an IV drip or intravenous cannula) is a short, hollow tube placed in the vein to allow administration of medications, fluids, or nutrients directly into the bloodstream.

The US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72-96 hours - ie every 3-4 days. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients, and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation.

The Cochrane researchers wanted to assess the effects of removing peripheral IV catheters when clinically indicated, compared with removing and re-siting the catheter routinely.

The Cochrane Review found no evidence of benefit to support the widespread current practice of changing catheters routinely.

What’s been the Impact of this Cochrane evidence?Upon assessment of these findings, healthcare organizations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings, and would also spare patients the unnecessary pain of routine re-sites in the absence of clinical indications. To minimize peripheral catheter-related complications in the context this revised procedure, insertions site should be inspected at each shift change and catheters removed if signs of inflammation, infiltration, or blockage are present.

This Cochrane Review directly informed two recommendations (IVAD29 and IVAD28) in the UK's National Institute for Health and Clinical Excellence (NICE) accredited national guideline for preventing healthcare-associated infections in National Health Service (NHS) hospitals in England (Epic3). These recommended implementing a clinically indicated strategy rather than routine replacement.

A recent cost analysis to asses how much adopting this evidence-based practice would save the NHS came to the following conclusions:

“To implement clinically indicated replacement of peripheral catheters, hospitals that currently undertake routine catheter replacement practice will need to update their policy… . [I]f only one-third of the 11.5 million hospital admissions to NHS England hospitals every year required peripheral venous catheterization for more than three days, the expected population for the proposed strategy implementation over five years would be around 20 million patients. Accordingly, we calculate that if the clinically indicated strategy was fully implemented in all NHS hospitals in England, then the cost savings to the system would be around ₤40 million over five years.”

“The Cochrane review stimulated heated debate and has been criticized by deworming advocates. In this case the Campbell replication – which included other study designs alongside randomized control trials – reaffirmed our findings which found no evidence of mass treatment having an impact on weight, height, haemoglobin, exam performance or mortality.

“Given the areas in which worms are most prevalent are often very poor there are usually other factors affecting the health of these children. Furthermore, living conditions are improving in many parts of the world and so the prevalence of worms and the number of serious infections is decreasing.”

Professor Paul Garner, LSTM, said: “Donors and philanthropists want magic bullets to eradicate poverty. The Cochrane review has shown clearly that deworming advocates have exaggerated the benefits of these programmes.

“With Cochrane and Campbell having such similar findings, the World Health Organization, policy makers and philanthropists need to take heed of the evidence and adjust their policies and investments”

Cochrane and MAGIC are delighted to announce the launch of an official partnership, aimed at supporting and further strengthening the use of health evidence within the context of a digital and trustworthy evidence ecosystem for health care.

MAGIC (formally known as the MAking GRADE the Irresistible Choice (MAGIC) organization) is a non-profit research and innovation programme set up to make evidence summaries and recommendations that work for clinicians at the point of care and to facilitate shared decision-making with patients. Established in 2010, the MAGIC project has, among a number of other initiatives, developed the MAGICapp, a web-based platform for preparing guidelines using structured data systems and validated methods.

Cochrane and MAGIC wish to continue a history of working together by establishing a formal partnership to harmonize the flow of data from systematic reviews to guidelines development and decision support systems. To this end, the organizations have signed a Memorandum of Understanding to structure and focus our collaborative work for the next three years.

Mark Wilson, Cochrane CEO, said: ‘We are delighted to be deepening our relationship with MAGIC through this new partnership. Cochrane and MAGIC share a passion for innovation, collaboration and commitment to making health and healthcare evidence more accessible and usable. I’m excited that by working more closely with MAGIC over the coming years we can extend the reach and influence of Cochrane evidence from individual patients to international health policy makers.’

Per Olav Vandvik, MAGIC Project Leader, concurred: ‘This partnership agreement recognizes the many areas of current and potential collaboration that MAGIC and Cochrane share. We look forward to working more closely together to help shape the future of the evidence ecosystem.’